| NPI | 1023091857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 25691) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22722) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 13717-320) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 80188) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2026-02-02 |